Table 2.
Potential Revenue per PCP FTE and per Medicare Patient Visit
| Code | Median Annual Revenue for Services for Already Provided but Not Billed (Lower Bound), $ (25th–75th Percentile) | Median Annual Revenue for Services If Provided to Half of All Eligible Patients (Upper Bound), $ (25th–75th Percentile) | ||
|---|---|---|---|---|
|
|
||||
| Per PCP FTE | Per Medicare Patient Visit | Per PCP FTE | Per Medicare Patient Visit | |
|
| ||||
| Prevention codes | ||||
| Smoking cessation counseling | 638 (134–1143) | 0.38 (0.08–0.68) | 1699 (119–3280) | 1.01 (0.07–1.96) |
| Alcohol misuse screening | 9282 (1942–16 622) | 5.54 (1.16–9.91) | 8269 (1730–14 808) | 4.93 (1.03–8.83) |
| Alcohol misuse counseling | 891 (484–1834) | 0.69 (0.29–1.09) | 4190 (1572–10 620) | 3.64 (0.94–6.33) |
| Depression screening | 3270 (684–5856) | 1.95 (0.41–3.49) | 7843 (1641–14 045) | 4.68 (0.98–8.38) |
| Behavioral counseling for cardiovascular disease | 7429 (4034–15 292) | 5.76 (2.41–9.12) | 7954 (4319–16 373) | 6.17 (2.58–9.76) |
| Obesity counseling | 3860 (2096–5625) | 2.30 (1.25–3.35) | 9060 (3400–14 720) | 5.40 (2.03–8.78) |
| Shared decision making for lung cancer screening | 90 (19–162) | 0.05 (0.01–0.10) | 1269 (266–2273) | 0.76 (0.16–1.36) |
| Advance care planning | 14 726 (3081–26 370) | 8.48 (1.84–15.73) | 38 745 (8107–69 384) | 23.11 (4.83–41.38) |
| Wellness visit* | – | – | 45 406 (9501–81 312) | 27.08 (5.67–48.49) |
| Total | 40 187 (12 474–42 903) | 25.46 (7.44–43.48) | 124 435 (30 654–226 813) | 76.78 (18.28–135.27) |
| Excluding wellness visits | 40 187 (12 474–42 903) | 25.46 (7.44–43.48) | 79 029 (21 153–145 502) | 49.70 (12.62–86.78) |
| Coordination codes | ||||
| Transitional care management† | 9293 (1944–16 642) | 5.54 (1.16–9.92) | 12 395 (2594–22 197) | 7.39 (1.55–13.24) |
| Chronic care management*‡ | – | – | 45 556 (9532–81 579) | 27.17 (5.68–48.65) |
| Behavioral health integration*‡ | – | – | 15 239 (3189–27 290) | 9.09 (1.90–16.28) |
| Cognitive assessment with care planning services*† | – | – | 12 891 (2697–23 085) | 7.69 (1.61–13.77) |
| Total | 9293 (1944–16 642) | 5.54 (1.16–9.92) | 86 082 (18 011–154 152) | 51.34 (10.74–91.94) |
| All codes | ||||
| Total for prevention and coordination codes | 49 480 (14 418–89 544) | 31.00 (8.60–53.40) | 210 517 (48 665–380 965) | 128.11 (29.02–227.21) |
FTE = full-time equivalent; PCP = primary care physician.
Estimate for the indicated codes are confined to the upper bound (50% of the eligible) because the codes for wellness visits, chronic care management, behavioral health integration, and cognitive assessment with care planning services require a suite of services that are not routinely provided.
Because these codes may displace an existing office visit, estimates are incremental—i.e., additional revenue on top of an evaluation and management visit of moderate complexity.
For chronic care management and behavioral health integration, which require substantial work by non-PCP personnel, these represent profit as revenue minus the costs of the non-PCP personnel.